A rare case of esophageal submucosal dissection thought to be caused by spontaneous intramural hematoma of the esophagus

Abstract

A woman in her seventies underwent surgery for the removal of varicose veins from a lower extremity under general anesthesia. After extubation, the patient developed vomiting and severe precordial chest pain. On the following day, tarry stool was noted. However, as no blood clots were observed in a gastric lavage and tarry stool was seen only once, esophagogastroduodenoscopy (EGD) was not performed. As the postoperative clinical course was uneventful and obvious recovery was observed, the patient was discharged. Subsequently, the woman was referred to our hospital for management of persistent precordial chest pain. An EGD performed as a preoperative procedure about two weeks prior to the surgery had not revealed any abnormality of the esophagus. However, a repeat EGD performed about one month post-surgery showed submucosal dissection and mucosal bridge from the middle to lower esophagus. Judging by the clinical course, the cause of the symptoms was considered to be spontaneous intramural hematoma of the esophagus associated with the vomiting reflex after extubation. EGD was performed again about six months later, which revealed no change in the state of the submucosal dissection. Lugol solution spraying revealed deep staining of the dissection plane, and regeneration of the mucosal surface layer was confirmed by biopsy. We report here this rare case of esophageal submucosal dissection caused by spontaneous intramural hematoma of the esophagus along with a literature review.